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Maine rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.95 / $115.88 / $124.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.95 / $81.31 / $81.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.44 / $154.44 / $154.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $60.49
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.24 / $115.88 / $124.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.95 / $81.31 / $124.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $87.41